tbuckley/cabot-search huggingface dataset:
Overall survival trends of papillary thyroid cancer: A Surveillance, Epidemiology, and End Results (SEER) population-based data (2002-2016).
Authors: Patil Balozian, Abdul Rahman Al Armashi, Antoine Boustany, Poornanand Palaparty
Journal: Journal of Clinical Oncology (2023)

e18108 Background: In the United States, the 5-year survival rate for patients with thyroid cancer is 98%. However, survival rates are mainly influenced by the type of thyroid cancer and the stage of the disease. The tremendous research in the area and the need to assess outcomes of recently implemented treatments necessitate the evaluation of the epidemiology and overall survival rates of the most common type of this malignancy, papillary thyroid cancer (PTC). Although the cause-specific survival (CSS) of Papillary Thyroid Cancer (PTC) patients has been extensively investigated, the overall survival (OS) of these patients is unclear. In this study, we aim to conduct an evaluation of survival trends after PTC diagnosis by stage of disease for the years 2002 through 2016 in the United States. Methods: We used the SEER 9 database to study PTC cases during 2002-2016. The patient survival data for the three disease stages (local, regional, and distal) were compared for the two time periods of interest, (2002-2008) and (2009-2016). The data for each cohort were split into six groups, (those whose deaths were in each of the five one-year intervals and those surviving the five-year follow-up period). These categorical counts were compared by the chi-square test of contingency table data. Statistical significance was taken as a p-value less than 0.05. Results: We reviewed 73,333 PTC cases in the United States from 2002 through 2016. There was an overall survival improvement with the exception of the distal stage, which did not demonstrate any statistical difference in the 2-time frames of interest. For local sites, there was a highly significant difference between the survival distributions of patients in the two time periods of interest (p = 0.0095; chi-square test statistic = 15.20 with 5 degrees of freedom). For regional sites, there was a highly significant difference between the survival distributions of patients in the two time periods of interest (p = 0.0077; chi-square test statistic = 15.72 with 5 degrees of freedom). For the distant stage, there was no significant difference between the survival distributions of patients in the two time periods of interest (p = 0.28; chi-square test statistic = 6.25 with 5 degrees of freedom). Conclusions: PTC’s survival rates have shown an improvement over the years 2002 through 2016, mostly noted in the local and regional stages. Although most patients with PTC have a favorable prognosis when conventional treatments are implemented, local recurrence and distant metastasis of advanced PTCs still hamper the survival and clinical management in certain patients.
Use of prophylactic and reactive feeding tubes in patients with esophageal cancer: A single-centre cohort study.
Authors: Yuchen Li, Rachel Reed, Gregory Russell Pond, Eglantina Moglica, Yee Ung, Susanna Y. Cheng, Ines B. Menjak, Mark Doherty, Amandeep Taggar
Journal: Journal of Clinical Oncology (2023)

e18694 Background: Esophageal cancer (EC) patients suffer from significant cachexia prior to and during treatment with chemotherapy and radiation (CRT). Feeding tubes can become the primary form of nutritional support for these patients during and after completion of treatment. Our primary objective was to identify factors that can predict EC patients at high risk of requiring feeding tube insertion. Methods: A retrospective cohort review was completed. All patients with an EC diagnosis made from January 1, 2013 to December 31, 2018 were included. Baseline characteristics of all patients and those receiving feeding tubes were collected. A multivariate logistic regression was performed comparing the group that required a reactive feeding tube insertion to those who did not require any feeding tube insertion to identify risk factors. Results: A total of 350 patients were included in the study, and 132/350 (38%) patients received a feeding tube, with gastrostomy tube being the most common type inserted (72%). 82 out of 132 (62%) patients had feeding tube inserted prophylactically, while 50/132 (38%) patients had feeding tube inserted reactively. Amongst patients who had a feeding tube inserted, median age was 67 years old, with 74% being male. Fifty-one out of 132 (39%) were adenocarcinoma, 75/132 (57%) were squamous cell carcinoma, 5/132 (4%) were neuroendocrine, and 1/132 (1%) was lymphoma. Severe dysphagia (OR 19.9, 95% CI 2.6-151.2, p &lt; 0.001) at diagnosis and decision to undergo chemotherapy (OR 2.8, 95% CI 1.3-5.8, p = 0.008) appeared to be predictors for reactive feeding tube insertion. Complications relating to feeding tubes were seen in 24/50 (48%) of the reactive insertion group and 34/82 (41%) of the prophylactic insertion group (p = 0.48). Conclusions: In this single-centre cohort study, severe dysphagia and undergoing chemotherapy were identified as risk factors for requiring a feeding tube later on. Future prospective studies can further explore other risk factors that may predict those at high risk of requiring a feeding tube, especially as it appears that those who have feeding tubes inserted reactively may have more complications than those who have feeding tube inserted prophylactically.
Trends and survival of malignant mesothelioma across racial groups between 2000-2019: A real-world study.
Authors: Abdul Rahman Al Armashi, Akram Alkrekshi, Anas Al Zubaidi, Faris Hammad, Dina Elantably, Omar Mahmood, Vien Truong, Tam N.M. Ngo, Debora S. Bruno
Journal: Journal of Clinical Oncology (2023)

e20539 Background: Malignant mesothelioma of the pleura (MMP) is a rare and aggressive malignancy and predominantly affects patients of White race in the U.S. Despite treatment advancements, the 5-year survival rate remains between 5% and 10%. Studies assessing racial disparities in MMP are lacking. We conducted a retrospective study to evaluate prevalence, survival and mortality trends among racial groups. Methods: We used the SEER database to determine the racial prevalence of all histological subtypes of MMP between 2000 and 2019. We calculated racial and histological subtype survival Cox proportional hazard ratios while controlling for age, gender, ethnicity, surgery, chemotherapy, and radiation use. Second, we used the CDC WONDER database to identify all mesothelioma deaths for the same period. Age-adjusted mortality (AAM) rates per 100,000 persons were standardized to 2000 US census data and stratified by race. Results: A total of 12791 patients were identified, mostly White (95%), followed by Blacks (%5) and Asians (0.4%). The percentages of patients with epithelioid, sarcomatoid and biphasic histologies were as follows: Whites (67.6%, 19.2%, 13.2%), Blacks (70.4%, 19.4%, 10.1%), and Asians (64.4%, 23.6%, 11.9%). As demonstrated in Table 1, compared to Whites, regardless of stage, survival was worse for Blacks (HR 1.16) and Asians (HR 1.14). As expected, survival was inferior for pts with sarcomatoid MMP followed by biphasic. Epithelioid MMP had the most favorable prognosis. Lastly, using the CDC WONDER database over the same period, there were 47,323 White, 2,068 Black, and 541 Asian MMP deaths. AAM was 0.8, 0.3, and 0.2 per 100,000 persons for White, Black, and Asian patients, respectively. AAM declined from 2000 to 2019 by 22% (0.9 to 0.7) in White, 50% (0.4 to 0.2) in Black, and 33% (0.3 to 0.2) in Asian. Conclusions: This is one of the largest population-based studies analyzing MMP racial disparities and histologic subtypes. Mortality analysis revealed declines across all racial groups, with the greatest decline among Blacks, which is two-fold that of Whites. However, a survival gap between races and histological subtypes persists. Despite no differences in the prevalence of histologic subtypes, mortality was 16% higher for Black patients when compared to Whites. Asian patients also had a higher risk of death of 14%, though the aggressive sarcomatoid subtype was more prevalent in this racial group. Social determinants of health and biological differences, could be responsible. Further studies are needed. [Table: see text]
Impact of next generation sequencing on a clinicians’ first line treatment decision in patients with stage IV non-small cell lung cancer.
Authors: Ahmed Megahed, Dominick Zheng, Lie H. Chen, Reina Haque, Eric C McGary
Journal: Journal of Clinical Oncology (2023)

e21160 Background: National Comprehensive Cancer Network (NCCN) guidelines strongly recommend biomarker testing for patients with advanced non-small cell lung cancer (NSCLC), specifically with broad, panel-based sequencing via NGS. Our study characterized how clinicians utilized NGS testing to make first line treatment decisions in patients with stage IV NSCLC. Methods: We conducted a cross-sectional study of members within an integrated healthcare system (Kaiser Permanente Southern California) diagnosed with stage IV NSCLC who completed NGS testing (Strata Oncology) between May 2019 to June 2021. Treatment start dates were used to divide patients into those who started treatment before and after NGS results, and those who did not receive treatment after NGS results. Patients harboring alterations in seven genes (EGFR, ALK, ROS-1, BRAF, KRAS, RET, and MET) were considered candidates for targeted first line therapy. Results: A sample of 760 patients with stage IV NSCLC completed NGS testing. The mean time from NGS order to result was 25 days. Of the 760 in the sample, 284 (37%) and 262 (34%) initiated treatment before and after NGS results were reported, respectively, while the remaining 214 (28%) did not receive any treatment up to 120 days after the NGS results were reported. 43% (323/760) of the sample was found to have a targetable mutation on NGS, of whom only 38% (124/323) initiated first line treatment with a targeted therapy. 56/124 (45%) were treated with targeted therapy prior to NGS results and 68/124 (55%) were treated with targeted therapy after NGS results. 61% (118/193) of EGFR, ALK, or ROS mutated patients started targeted therapy. 67/323 with a driver mutation did not receive any treatment and were referred to hospice. For those patients who initiated targeted therapy prior to NGS results, it suggests that clinicians ordered single gene testing in parallel with NGS, and that these results were available prior to NGS. Conclusions: NGS tests results were not exclusively used to inform first line treatment decisions in most patients with stage IV NSCLC, as most patients found to have a targetable mutation, were not treated with targeted therapy. Possible explanations include lengthy turnaround times for NGS testing and the availability of more timely single gene testing.
Trends in the use of neoadjuvant chemotherapy for low-grade serous ovarian cancer in the United States.
Authors: Jason Silberman, Alexandra Bercow, Allison Ann Gockley, Eric L Eisenhauer, Rachel Sisodia, Thomas Christopher Randall, Alexander Melamed, Amy Bregar
Journal: Journal of Clinical Oncology (2023)

5581 Background: Following the publication of randomized trials demonstrating its noninferiority, the use of neoadjuvant chemotherapy (NACT) for the treatment of advanced stage epithelial ovarian cancer has increased substantially in the United States. However, low-grade serous ovarian cancers (LGSOC) respond poorly to chemotherapy compared with high-grade serous carcinoma. For LGSOC, clinical guidelines favor surgical resection prior to adjuvant therapy. This study seeks to describe patterns and temporal trends in the use of NACT for LGSOC. Methods: This cohort study identified women treated for stage III or IV LGSOC in a Commission on Cancer accredited cancer program between January 1, 2004, to December 31, 2020. We fit Poisson regression models to evaluate temporal trends in the use of NACT and cytoreductive outcomes, and to identify factors associated with receipt of NACT. We considered age, race/ethnicity, Charlson Comorbidity Index, year of diagnosis, insurance status, income, facility type, census region, and stage as potentially associated with NACT. Due to the high rate of missingness in data describing cytoreductive outcomes after surgery, we undertook both multiply imputed and complete case analyses. Results: A total of 3,343 patients received treatment for LGSOC during the study period. The mean age at diagnosis was 54.8 year (SD 15.5) and most patients (82%) were white. The most commonly observed upfront treatment strategies were cytoreductive surgery followed by adjuvant chemotherapy (63.7%) and surgery without chemotherapy (19.2%). Treatment with NACT followed by interval cytoreductive surgery (13.0%) or chemotherapy alone (4.1%) were less common. The proportion of patients who received NACT increased from 9.5% in 2004 to 25.9% in 2020, corresponding to a statistically significant annual percent change (APC) of 7.2% (95% CI 5.6-8.9). Increasing decade of age (risk ratio [RR] 1.15; 95% CI 1.09-1.23), increasing calendar year of diagnosis (RR 1.07; 95% CI 1.05-1.08) and stage IV disease (RR 2.66; 95% CI 2.3-3.07) were associated with a higher probability of receiving NACT. Other variables were not associated with receipt of NACT. Among patients who underwent cytoreductive surgery, the proportion who achieved no gross residual disease remained stable over the course of the study period in both complete case (APC 0.5%; 95% CI -1.8 to 0.9) and multiply imputed (APC -0.1%; 95% CI -1.6 to 1.3) analyses. Conclusions: The use of NACT for patients with LGSOC increased substantially from 2004 to 2020. Despite increased utilization of NACT, the rate of complete cytoreduction has not improved over the study period, possibly calling into question the effectiveness of NACT in reducing tumor burden in this setting.
Evaluating embedded geriatric care in gastrointestinal (GI) oncology program for older adults (OA): Feasibility and key learnings.
Authors: Nadine Jackson McCleary, Tammy Hshieh, Rachel Weitzner, Leila Rostamnjad, Lauren K. Brais, Nora K. Horick, Tamryn Gray, Jiping Wang, Jeffrey A Meyerhardt
Journal: Journal of Clinical Oncology (2023)

e24015 Background: Older adults with GI cancers experience frequent interruptions to life-improving care due to emergency department (ED) or unplanned hospital visits (UHV), with estimates ranging from 34-84% for advanced disease. Geriatric assessment can predict survival, toxicity, and completion of planned therapy but has been considered cumbersome for use in oncology practice. Geriatric co-management is now standard within certain primary care and subspecialty practices at the Brigham and Women’s Hospital (BWH), and has resulted in reduced mortality at 1-year, lower incidence of delirium, and improved provider/patient satisfaction. The REACH study (Resilience and Equity in Aging, Cancer, and Health) is a type III hybrid implementation mixed methods study that evaluates the ability of geriatric consultation to improve quality of life and reduce ED/UHV for pre-frail and frail OA diagnosed with GI cancer. Methods: We reviewed early data from the REACH study based in the Gastrointestinal Cancer Center at Dana-Farber Cancer Institute (DFCI) between Jan. 2022–Jan. 2023. Data included REACH-eligible patients scheduled for a new consult visit, OA patients continuing care at DFCI, percentage of patients consented to participate, and percentage of consented patients who completed the frailty questionnaire (EFA). Results: As of 1/31/2023, a total of 815 OA patients age 70+ were screened initially eligible. Consented patients completed the REACH EFA. Among the 815 patients initially eligible, 73.8% of OA patients aged 70-74 continued care at DFCI, along with 74.7% of patients age 75-79, and 73.5% of patients age 80-84. For patients 85 or older, 82.7% of patients continued their oncology care at DFCI. Patients who screened ineligible or declined to participate were due to either not continuing care at DFCI, preferred language other than English/Spanish, or initiating hospice care. From Jan. 2022 to Jan. 2023, n = 30 consented to participate with a 90% completion rate of the full EFA questionnaire (n = 27/30). Conclusions: Data for the REACH study is ongoing. We are now transitioning to a clinical program where consent is no longer needed to complete the REACH EFA questionnaire. DFCI has pivoted to EFA questionnaire being standard of care for OA patients due to its acceptability and importance. Future program efforts will improve patient language access and expand to additional DFCI regional sites around New England to ensure a more diverse population and provide tailored support for those patients who have a higher level of frailty and more complex needs throughout their cancer care journey. Clinical trial information: NCT04674267 .
Comparison of BRCA genetic testing and subsequent treatment with PARP inhibitors (PARPi) for ederly vs non-elderly women with non-mucinous epithelial ovarian cancer (EOC): A large prospective cohort study from the Australian National Gynaecology Oncology Registry (NGOR).
Authors: Mahendra Naidoo, Clare L. Scott, Orla McNally, Rob Rome, Sharnel Perera, John Raymond Zalcberg
Journal: Journal of Clinical Oncology (2023)

e17566 Background: The 5-year survival rate for elderly women (≥ 75 years) with ovarian cancer is 25%. Germline mutations in BRCA1/BRCA2 are identified in approximately 15% of newly diagnosed women with ovarian cancer and have implications for prognosis and predicted benefit of both platinum chemotherapy and PARPi therapy. Objectives: To compare differences in, and subsequent management of Elderly (aged ≥75 years) vs Non-elderly (aged &lt;75 years) women with non-mucinous EOC who underwent germline and somatic BRCA1/BRCA2 testing across the Australian NGOR sites from 2017 – 2022. Methods: Clinical data were sourced from NGOR patient databases and assessed to confirm accuracy prior to analysis. Results: Data on 1579 eligible women between May 2017 and July 2022 across 21 hospitals were collected. Patient characteristics are summarised in Table 1. The rates of germline testing in Elderly women was 51% compared to 71% in Non-elderly women and this difference was statistically significant (p&lt;0.001). The rates of somatic testing in Elderly women was 28% compared to 33% in Non-elderly women although this difference was not statistically significant (p=0.2). In Elderly women with either germline or somatic pathogenic BRCA mutations and Stage III/IV disease, 67% received PARPi within 8 weeks of chemotherapy completion compared to 53% in Non-elderly women. In a multi-variate analysis, the most significant characteristic associated with reduced germline testing was the ‘Elderly’ compared to ‘Non-elderly’ group (OR 0.41, 95% CI: 0.30-0.58, p &lt; 0.001). Germline testing was more likely to be conducted in postcodes associated with higher Socioeconomic status (SES) quintiles 2-5 compared to quintile 1 (OR 2.06, 95% CI: 1.50-2.81, p&lt; 0.001) and in those women receiving operative and chemotherapy treatment compared to chemotherapy alone (OR 1.84, 95% CI: 1.08-3.11, p=0.024). Conclusions: The rates of germline and somatic BRCA testing are lower than anticipated, particularly germline testing in Elderly women. Women known to have pathogenic germline or somatic BRCA mutations may have received PARPi at lower rates than expected. Further studies are required to understand the cause of such variations, including accounting for the advent of government funded BRCA testing, PARPi funding and correlating effects on survival. [Table: see text]
Effects of concomitant gut-microbiome altering medications on immune checkpoint inhibitors therapy: A retrospective study.
Authors: Rohit Singh, Akshee Batra, Samantha R Schuetz, Helen Gandler, Jacob Barker, Derek Devine, Hibba tul Rehman, David Alejos, Shahid Sattar Ahmed
Journal: Journal of Clinical Oncology (2023)

6617 Background: In cancer patients, gut microbiota influences the antitumor immune response, efficacy, and safety of immune checkpoint inhibitors (ICIs). Antibiotics (ATBs), proton pump inhibitors (PPIs), and corticosteroids can alter the distribution of gut microbiota, resulting in dysbiosis, which can potentially reduce the efficacy of ICIs and may contribute to increased incidence of immune-related adverse effects (irAEs). Methods: We conducted a retrospective observational study to investigate the influence of concurrent medicines on patients receiving ICIs at the University of Vermont Cancer Center. We examined the medical records of people who received ICIs alone or in combination with chemotherapy or targeted therapy as a first-line therapy between January 2017 and June 2022. Patients who got ATBs, PPIs, and corticosteroids (&gt;10 mg prednisone) one month before commencing ICIs and during the first six months of treatment were compared to those who did not. We looked at the relative risk for overall survival and the occurrence of irAEs in both cohorts. Results: We identified 266 patients, of which 99 (37%) have died. The mean age was 64 years, 55% were male, and 97% of the patients were White. Lung cancer was the most commonly identified malignancy at 36%, and 55% of the cancers were stage IV. The median ECOG was 1, and the median Charlson morbidity index was 6. Of the total cohort, 62% received antibiotics, 67% received steroids, 45% received PPIs, 31% received two of the three, and 27% received all three. The relative risk (RR) of death in the cohort which received antibiotics was 1.53 (p = 0.02), the cohort which received steroids was 1.73 (p = 0.006), and the cohort that received PPIs was 1.61 (p = 0.006). For the group that received two or all three medications, the RR was 2.18 (p = 0.003). Regarding irAEs, the group that received steroids had a RR of 2.13 (p = 0.07); however, most of these patients likely received steroids for an irAE. Antibiotics and PPIs were not associated with a higher risk of irAEs. One of the significant limitations of our study is the small sample size and the retrospective data collection. Data is also confounded because it includes patients who have received ICIs in combination with chemotherapy or other agents. Conclusions: Our study suggests that patients who received any of the gut microbiome-modifying medications before starting and within the early phase of ICIs treatments are at higher risk of mortality, likely owing to the poor efficacy of ICIs or possibly because these patients are sicker at baseline. However, we must be judicious with using such medications when patients undergo treatment with ICIs. Large prospective studies looking at this association are needed to understand the risk and potential outcomes. [Table: see text]